| NPI | 1760669238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT22924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012332) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2023-01-24 |